动静脉内瘘不同手术方式对血液透析病人心功能的影响

目的:探讨动静脉内瘘不同手术方式对血液透析病人心功能的影响。方法:选择行动静脉内瘘术治疗的尿毒症病人60例，其中端-端吻合、端-侧吻合各30例，观察病人动静脉内瘘及心功能情况，评价动静脉内瘘不同手术方式对病人心功能的影响。结果:端-侧吻合组术后平均血流量和平均直径均高于端-端吻合组（P<0.01）；端-侧吻合组术后1年心指数明显上升，射血分数明显下降，与端-端吻合组差异均有统计学意义（P<0.01）；2组内瘘失败发生率差异均无统计学意义（P>0.05）。结论:对选择动静脉内瘘手术治疗的血液透析病人，端-侧吻合是一种既能确保透析血流量，又不会增加病人心脏负荷的一种手术方式，值得推广。

Effect of different surgical methods in the treatment of arteriovenous fistula on cardiac function in hemodialysis patients

Objective:To investigate the effects of different surgical methods in the treatment of arteriovenous fistula on cardiac function in hemodialysis patients.Methods:Sixty uremic patients were treated with end-to-end arteriovenous fistula anastomosis(30 cases) and end-to-side arteriovenous fistula anastomosis(30 cases).The arteriovenous fistula and heart function in all patients were observed,and the effects of different surgical methods on cardiac function were evaluated.Results:The postoperative average blood flow and diameter in end-to-side anastomosis group were higher than those in end-to-end anastomosis group(P<0.01).After 1 year of operation,the cardiac index significantly increased,and the ejection fraction significantly decreased in end-to-side anastomosis group,and the differences of the cardiac index and ejection fraction between two groups were statistically significant(P<0.01).The difference of the incidence rate of the fistula failure between two groups was not statistically significant(P>0.05).Conclusions:The end-to-side anastomosis in the treatment of arteriovenous fistula in hemodialysis patients can ensure the blood flow,does not increase the heart load,which is worthy of promotion.